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Identification of processes that mediate the impact of workplace violence on emergency department healthcare workers in the USA: results from a qualitative study
  1. Marie C Vrablik MD1,
  2. Anne K Chipman1,
  3. Elizabeth D Rosenman1,
  4. Nancy J Simcox2,
  5. Ly Huynh1,
  6. Megan Moore3,4,
  7. Rosemarie Fernandez5
  1. 1Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
  2. 2Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
  3. 3University of Washington School of Social Work, Seattle, Washington, USA
  4. 4Harborview Injury Prevention and Research Center, Seattle, Washington, USA
  5. 5Emergency Medicine, University of Florida Health Science Center Jacksonville, Jacksonville, Florida, USA
  1. Correspondence to Dr Rosemarie Fernandez; fernandez.r{at}


Objectives Violence towards emergency department healthcare workers is pervasive and directly linked to provider wellness, productivity and job satisfaction. This qualitative study aimed to identify the cognitive and behavioural processes impacted by workplace violence to further understand why workplace violence has a variable impact on individual healthcare workers.

Design Qualitative interview study using a phenomenological approach to initial content analysis and secondary thematic analysis.

Setting Three different emergency departments.

Participants We recruited 23 emergency department healthcare workers who experienced a workplace violence event to participate in an interview conducted within 24 hours of the event. Participants included nurses (n=9; 39%), medical assistants (n=5; 22%), security guards (n=5; 22%), attending physicians (n=2; 9%), advanced practitioners (n=1; 4%) and social workers (n=1; 4%).

Results Five themes emerged from the data. The first two supported existing reports that workplace violence in healthcare is pervasive and contributes to burn-out in healthcare. Three novel themes emerged from the data related to the objectives of this study: (1) variability in primary cognitive appraisals of workplace violence, (2) variability in secondary cognitive appraisals of workplace violence and (3) reported use of both avoidant and approach coping mechanisms.

Conclusion Healthcare workers identified workplace violence as pervasive. Variability in reported cognitive appraisal and coping strategies may partially explain why workplace violence negatively impacts some healthcare workers more than others. These cognitive and behavioural processes could serve as targets for decreasing the negative effect of workplace violence, thereby improving healthcare worker well-being. Further research is needed to develop interventions that mitigate the negative impact of workplace violence.

  • qualitative research
  • burnout
  • accident & emergency medicine
  • wellness

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  • Contributors MCV and AKC contributed equally to this manuscript and are joint first authors on this manuscript. MCV and RF conceived of the study and analysis plan. All authors (MCV, EDR, AKC, LH, MM, NJS and RF) participated in developing interview tools. MCV, EDR, AKC, LH, MM and RF performed analyses. MCV, AKC and RF wrote the first draft of the manuscript. RF and AKC drafted the conceptual model presented in the manuscript. All authors (MCV, EDR, AKC, LH, MM, NJS and RF) contributed to interpretation of the data, substantially edited the manuscript and approved of the final version. RF takes final responsibility for the manuscript as a whole.

  • Funding RF, MCV, AKC, LH, MM and NJS were funded by the State of Washington, Department of Labor and Industries, Safety and Health Investment Projects, 2014XH00293.

  • Disclaimer The funding source had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review or approval of the manuscript.

  • Competing interests RF, MCV, LH, MM, AKC and NJS received funding from the State of Washington, Department of Labor and Industries, Safety and Health Investment Projects. RF, EDR, AKC and MCV received funding from the Department of Defense. RF and EDR received funding from the Agency for Healthcare Research and Quality.

  • Patient consent for publication Not required.

  • Ethics approval This work was approved by the University of Washington Institutional Review Board (STUDY00000502).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

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